The experience of different imaging methods in the diagnosis of traumatic diaphragmatic hernia
-
摘要:
目的通过不同影像学检查方法诊断两例创伤性膈疝的过程中，得到的经验教训，探讨并寻找价廉的、能方便快捷地、较为准确地诊断创伤性膈疝的方法，同时又要避免因患者不能配合所造成的干扰：如昏迷、烦躁、乱动等 方法收集两例创伤性膈疝患者影像学及临床、手术资料：一例因值班医师考虑不充分，仅作胸腹部CT平扫+膈肌薄层三维重建；一例经充分考虑后作胸腹部CT检查（平扫+膈肌薄层三维重建）+透视+摄片（留取影像记录）。比对两例病例作出的诊断结果，征询临床意见及手术结果。 结果临床反馈意见及手术结果均证实，透视下的诊断结果结合临床能较为快捷、准确地作出诊断，且有其独到的科学性。 结论充分认识膈疝的影像学表现、熟练掌握各种鉴别诊断、认真结合临床症状及体征，对于快捷准确地诊断创伤性膈疝并不难，从而更有效地减少死亡率、降低并发症以及提高治愈率。 Abstract:Objective Through the process of different imaging methods in the diagnosis of two cases of traumatic diaphragmatic hernia, get lessons learned, and to discuss and look for cheap, convenient and quick to, more accurately the method in the diagnosis of traumatic diaphragmatic hernia, at the same time avoid interference caused by patient can't cooperate, such as coma, be agitated, touch, etc. Methods Collect the images of two cases of traumatic diaphragmatic hernia and clinical data, operation: In one case, because the doctor on duty to consider is not sufficient，only the chest and abdomen CT scan + diaphragm thin layer 3 d reconstruction; Another case after taking full account of the chest and abdomen CT examination（CT scan + diaphragm thin layer 3 d reconstruction）+ X-ray fluoroscopy + X-ray radiography (leave medical image data). Then compare the diagnostic results of the two cases, the clinical observations and surgical results. Results Clinical feedback and surgical results were confirmed, the diagnosis results of X-ray fluoroscopy diagnosis combined with clinical can be more quick and accurate diagnosis, and has its unique scientific nature. Conclusion Fully aware of the imaging findings of diaphragmatic hernia, skillfully master all kinds of differential diagnosis, seriously in combination with clinical symptoms and signs, for fast and accurate diagnosis of traumatic diaphragmatic hernia is not difficult, so as to more effectively reduce mortality, reduce complications and improve cure rate. -
[1] 孙玉鹗, 黎介寿, 吴孟超, 等. 胸外科手术学[M]. 2版. 北京: 人民军医出版社, 2004: 468-70. [2] 李艳英, 王彦民, 赵德利, 等. 多层螺旋CT在创伤性膈疝诊断中的应用[J]. 实用放射学杂志, 2011, 27(11): 1667-9. [3] 李向东, 周灵飞, 马双慰, 等. 14例多发伤合并创伤性膈疝漏诊分析[J]. 重庆医学, 2011, 40(29): 2979-81. http://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201129027.htm [4] 常鹏, 乌立晖, 钱鼎烽. 右侧闭合性创伤性膈疝1例报告[J]. 山东医药, 2011, 51(34): 14. http://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201134011.htm [5] 樊晨, 院存珍. 迟发性创伤性膈疝一例误诊报告[J]. 临床误诊误治,2014, 27(5): 27-8. http://www.cnki.com.cn/Article/CJFDTOTAL-LCWZ201405011.htm [6] 徐翔, 王启斌, 吕必宏, 等. 创伤性膈疝14例的诊断与治疗[J]. 海南医学, 2012, 23(2): 71-2. http://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201202033.htm [7] 高红霞, 齐书山, 祁昕, 等. 创伤性膈疝的早期诊治及误漏诊原因分析: 附56例报告[J]. 中国医师进修杂志, 2013, 36(8): 63-5. [8] 崔祥义. 实用肺脏病学[M]. 上海: 上海科学技术出版社, 1991: 562. [9] 宋志明, 吴起才, 凌翔. 膈肌膨升症2例报告[J]. 南昌大学学报:医学版, 2010, 50(8): 100, 103. http://www.cnki.com.cn/Article/CJFDTOTAL-JXYB201008041.htm [10] 葛孝忠, 吕剑剑, 陈业庭, 等. 成人膈肌膨出症3例报告[J]. 东南大学学报: 医学版, 2011, 30(6): 917-20. http://www.cnki.com.cn/Article/CJFDTOTAL-NJTD201106024.htm [11] 姚晓群, 杨小军, 王霞, 等. CT扫描与X线平片影像学诊断膈疝灵敏度､特异度的对比分析[J]. 国外医学:医学地理分册, 2013, 34(2):122-4, 136. http://www.cnki.com.cn/Article/CJFDTOTAL-GONE201302020.htm [12] 郭志金, 韩晓梅, 张昌明. 胸腹部CT三维重建在创伤性膈疝诊疗中的应用[J]. 中华创伤杂志, 2013, 29(3): 224-5. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhcs201303008 -
下载:
点击查看大图
图(2)
计量
- 文章访问数: 463
- HTML全文浏览量: 170
- PDF下载量: 0
- 被引次数: 0
